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Mortality Gap for Seriously Mentally Ill Widens

It is well-established that individuals with bipolar disorder and schizophrenia live much shorter lives than the rest of the population, dying an estimated 10 to 25 years younger, depending on the nation where they reside.

Now, new evidence from an analysis of nearly 40,000 health records in the United Kingdom from 2000 to 2014 indicates the mortality gap between the two populations is growing larger.

Mortality Trends

Overall, death rates from all causes declined since 2000 both for the general population and for individuals with bipolar and schizophrenia. However, since the mid-2000s, death rates for the general population have fallen further and faster than for individuals with one of the two diseases, according to the new study.

“This suggests . . . health inequalities are growing,” Joseph F. Hayes and colleagues write in the British Journal of Psychiatry online. “This is despite a greater focus on this problem at a national and international level, in specialist, primary care and public health settings.”

Overall, the death rate from all causes was 1.77 times greater in 2014 for individuals with bipolar disorder and 2.08 times greater for those with schizophrenia, even after adjusting for risk factors such as smoking, high cholesterol, high blood pressure, obesity, diabetes and sociodemographic factors.

Three health indicators were found central to the mortality gap for serious mental illness: rates of cardiovascular disease, suicide and self-harm.

Inequity in Medical Care Access

In people aged 16-50, the death rate from cardiovascular disease was 2.5 times higher for individuals with schizophrenia than for those the same age in the general population. Despite the heightened risk, they were found to be infrequently diagnosed with heart disease prior to death, and women were less likely to be diagnosed than men.

This suggests that persons with serious mental illnesses continue to experience lower access to physical health care, due to reluctance or inability to seek care; lack of insurance; and provider bias against trusting reports of physical symptoms by people with mental issues.

Suicide and Self-Harm Risks

Individuals with bipolar disorder were 12.66 times more likely to die of suicide than the comparison group in the general population; those with schizophrenia were 7.21 times more likely to kill themselves than the comparison group. In both conditions, the disparity was found irrespective of gender, age or time of year.

Self-harm – a significant risk factor for suicide – also was found much more prevalent among those with the two diseases, especially those under the age of 50. For all ages, the risk of self-harm was 25 times higher for individuals with bipolar disorder and 22 times higher for those with schizophrenia. In the 16-50 age cohort, the risk of suicide was 56 times higher for individuals with bipolar and 52 times higher for those with schizophrenia.

The authors of the study speculate that closure of psychiatric beds is the source of the growing mortality gap.

“Although deinstitutionalization has been a success in terms of integrating people into wider society, it has been argued that there is now too little support for people living with bipolar disorder and schizophrenia in the community, and this may be reflected in mortality rates,” they write.

 

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